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1.
Ann Ital Chir ; 92: 280-285, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36052458

RESUMO

AIM: Recurrent episodes of chronic tonsillitis (CT) can affect a patient's quality of life, physical and mental health. Clinicians often perform surgeries to remove them. Traditional surgical methods are varied, despite their advantages. However, this remains controversial. This study aimed to examine both the safety and efficacy of low-temperature plasma tonsillectomy (LTPT) in treatment of chronic tonsillitis, which may provide a substitute for clinicians and compensate for the short supply of therapeutic procedures. METHODS AND ANALYSIS: This protocol is guided by the Preferred Reporting Items for Systematic. REVIEW AND META-ANALYSIS: Protocols (PRISMA-P) and by the Cochrane Collaboration Handbook. We will formulate strict inclusion and exclusion criteria in English databases (PubMed, EMBASE, and Web of Science) and search literature in different clinical registration platforms (Cochrane Library). The including articles were evaluated by the Cochrane RCT evaluation criteria. The primary main endpoints will include the duration of operation, blood loss during surgery, time of formation and exfoliation of the pseudomembrane, average pain and duration post-operation, and time for normal diet. The Secondary endpoints will include complications of postoperative bleeding and infection. Stata 15.0 will be used for data analysis. Subgroup analysis, sensitivity analysis, and meta-regression were used to detect the sources of heterogeneity. Begg's Test will quantitatively detect publication bias quantitatively. ETHICS AND DISSEMINATION: The results of this meta-analysis and meta-regression will be disseminated through publication in a peer-reviewed journal. The data used in this meta-analysis will not contain individual patient data; therefore, ethical approval is not required. KEY WORDS: Chronic tonsillitis, Low-temperature plasma tonsillectomy, Meta-analysis, Protocol, Systematic review.


Assuntos
Tonsilectomia , Tonsilite , Doença Crônica , Humanos , Metanálise como Assunto , Qualidade de Vida , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Temperatura , Tonsilite/cirurgia
2.
BMJ Open ; 12(9): e062722, 2022 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-36104143

RESUMO

INTRODUCTION: The standard surgical treatment for recurrent or chronic tonsillitis is extracapsular tonsillectomy. Recent studies show that intracapsular tonsillectomy has the potential to reduce the postoperative morbidity of patients undergoing tonsil surgery. The Finnish Intracapsular Tonsillectomy (FINITE) trial aims to provide level I evidence to support the hypothesis that the recovery time from tonsil surgery can be reduced with intracapsular tonsillectomy. Additionally, from this trial, major benefits in quality of life, reduction of postoperative complications, treatment costs and throat symptoms might be gained. METHODS AND ANALYSIS: The FINITE trial is a prospective, randomised, controlled, patient-blinded, three-arm clinical trial. It is designed to compare three different surgical methods being extracapsular monopolar tonsillectomy versus intracapsular microdebrider tonsillectomy versus intracapsular coblation tonsillectomy in the treatment of adult patients (16-65 years) suffering from recurrent or chronic tonsillitis. The study started in September 2019, and patients will be enrolled until a maximum of 200 patients are randomised. Currently, we are in the middle of the study with 125 patients enrolled as of 28 February 2022 and data collection is scheduled to be completed totally by December 2027. The primary endpoint of the study will be the recovery time from surgery. Secondary endpoints will be the postoperative pain scores and the use of analgesics during the first 3 weeks of recovery, postoperative haemorrhage, quality of life, tonsillar remnants, need for revision surgery, throat symptoms, treatment costs and sick leave. A follow-up by a questionnaire at 1-21 days and at 1, 6, 24 and 60 months will be conducted with a follow-up visit at the 6-month time point. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Medical Ethics Committee of the Hospital District of Southwest Finland (reference number 29/1801/2019). Results will be made publicly available in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT03654742.


Assuntos
Tonsilectomia , Tonsilite , Adulto , Doença Crônica , Finlândia , Seguimentos , Humanos , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Tonsilite/cirurgia
3.
Lancet ; 400(10353): 661-669, 2022 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-35952705

RESUMO

BACKGROUND: In May, 2022, several European countries reported autochthonous cases of monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We aimed to investigate clinical and virological characteristics of cases of human monkeypox in Spain. METHODS: This multicentre, prospective, observational cohort study was done in three sexual health clinics in Madrid and Barcelona, Spain. We enrolled all consecutive patients with laboratory-confirmed monkeypox from May 11 to June 29, 2022. Participants were offered lesion, anal, and oropharynx swabs for PCR testing. Participant data were collected by means of interviews conducted by dermatologists or specialists in sexually transmitted infections and were recorded using a standard case report form. Outcomes assessed in all participants with a confirmed diagnosis were demographics, smallpox vaccination, HIV status, exposure to someone with monkeypox, travel, mass gathering attendance, risk factors for sexually transmitted infections, sexual behaviour, signs and symptoms on first presentation, virological results at multiple body sites, co-infection with other sexually transmitted pathogens, and clinical outcomes 14 days after the initial presentation. Clinical outcomes were followed up until July 13, 2022. FINDINGS: 181 patients had a confirmed monkeypox diagnosis and were enrolled in the study. 166 (92%) identified as gay men, bisexual men, or other men who have sex with men (MSM) and 15 (8%) identified as heterosexual men or heterosexual women. Median age was 37·0 years (IQR 31·0-42·0). 32 (18%) patients reported previous smallpox vaccination, 72 (40%) were HIV-positive, eight (11%) had a CD4 cell count less than 500 cells per µL, and 31 (17%) were diagnosed with a concurrent sexually transmitted infection. Median incubation was 7·0 days (IQR 5·0-10·0). All participants presented with skin lesions; 141 (78%) participants had lesions in the anogenital region, and 78 (43%) in the oral and perioral region. 70 (39%) participants had complications requiring treatment: 45 (25%) had a proctitis, 19 (10%) had tonsillitis, 15 (8%) had penile oedema, six (3%) an abscess, and eight (4%) had an exanthem. Three (2%) patients required hospital admission. 178 (99%) of 180 swabs from skin lesions collected tested positive, as did 82 (70%) of 117 throat swabs. Viral load was higher in lesion swabs than in pharyngeal specimens (mean cycle threshold value 23 [SD 4] vs 32 [6], absolute difference 9 [95% CI 8-10]; p<0·0001). 108 (65%) of 166 MSM reported anal-receptive sex. MSM who engaged in anal-receptive sex presented with proctitis (41 [38%] of 108 vs four [7%] of 58, absolute difference 31% [95% CI 19-44]; p<0·0001) and systemic symptoms before the rash (67 [62%] vs 16 [28%], absolute difference 34% [28-62]; p<0·0001) more frequently than MSM who did not engage in anal-receptive sex. 18 (95%) of 19 participants with tonsillitis reported practising oral-receptive sex. The median time from onset of lesions to formation of a dry crust was 10 days (IQR 7-13). INTERPRETATION: In our cohort, monkeypox caused genital, perianal, and oral lesions and complications including proctitis and tonsillitis. Because of the variability of presentations, clinicians should have a low threshold for suspicion of monkeypox. Lesion swabs showed the highest viral loads, which, combined with the history of sexual exposure and the distribution of lesions, suggests close contact is probably the dominant transmission route in the current outbreak. FUNDING: None.


Assuntos
Infecções por HIV , Varíola dos Macacos , Proctite , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis , Varíola , Tonsilite , Adulto , Feminino , Homossexualidade Masculina , Humanos , Masculino , Vírus da Varíola dos Macacos , Estudos Prospectivos , Comportamento Sexual , Espanha
4.
Laryngorhinootologie ; 101(8): 690-691, 2022 08.
Artigo em Alemão | MEDLINE | ID: mdl-35915908

Assuntos
Tonsilite , Humanos
5.
Biomed Res Int ; 2022: 8506242, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35993047

RESUMO

Epstein-Barr virus (EBV) is a common virus worldwide that is an etiologic agent in the development of many diseases, including cancer. Recent reports have shown the association of EBV with tumorigenesis in head and neck squamous cell carcinoma (HNSCC). Moreover, EBV has been reported to be present in tonsillar tissues, which suggests a close relationship between viral infections and tonsillar diseases, including chronic tonsillitis. The aim of the study was to analyze the prevalence of EBV DNA in 86 patients with HNSCC, in 70 patients with chronic tonsillitis, and in 144 healthy individuals (control group) and the associations between EBV infection and clinicopathological and demographic characteristics and the use of stimulants in all study groups. The objective of this study was also to analyze the prevalence of coinfection with human papillomavirus (HPV). After prior DNA isolation, EBV detection was performed using an EBV kit by real-time polymerase chain reaction. The prevalence of EBV infection in patients with HNSCC, patients with chronic tonsillitis, and the control group was 47.7%, 60%, and 24.3%, respectively. Compared to controls, a significantly higher prevalence of EBV in patients with chronic tonsillitis and HNSCC may suggest that EBV is a potential risk factor. No association was found between EBV infection and demographic or clinical data. Further studies are warranted due to inconclusive reports that were mainly related to geographic distribution, sample type, and detection technique. Considering the prevalence of the virus and the risk of serious diseases, attention should be paid to screening diagnosis and prevention of the infection.


Assuntos
Infecções por Vírus Epstein-Barr , Neoplasias de Cabeça e Pescoço , Tonsilite , DNA Viral/genética , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/epidemiologia , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/genética , Herpesvirus Humano 4/genética , Humanos , Reação em Cadeia da Polimerase , Carcinoma de Células Escamosas de Cabeça e Pescoço/epidemiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/genética , Tonsilite/complicações , Tonsilite/epidemiologia
6.
Int J Pediatr Otorhinolaryngol ; 159: 111224, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35785584

RESUMO

BACKGROUND: Tonsillitis is a common paediatric condition. The decision to seek medical attention and consent to treatment is usually made by parents or guardians. With increased accessibility of the internet, online medical information plays an increasingly significant role in the decision-making process. Little is known regarding the quality of online patient information on tonsillitis, as this has not been previously studied. OBJECTIVE: The aim of our study was to identify the quality of information regarding tonsillitis on websites intended for the public. METHODS: We conducted a systematic review of online information on tonsillitis using the following search terms: "Tonsillectomy", "Tonsillitis", "Adenotonsillectomy" and "Tonsil". The first three pages of returned websites were captured and each website was examined using the validated Ensuring Quality Information for Patients (EQIP) tool (score 0-36). RESULTS: A total of 92 websites met the inclusion criteria for analysis. The overall median EQIP score was 19 with an interquartile range of 17-22 and a maximum of 32. More than half of all websites originated from the USA (61%) and hospitals were the most common source of information (29%). Most websites failed to describe the quantitative benefits or address the medical intervention costs and insurance issues. Half of the websites included both tonsillectomy and antibiotics as treatments for tonsillitis. Only 68% included complications of tonsillitis or tonsillectomy. CONCLUSIONS: The assessment of the quality of online patient information websites regarding tonsillitis by the EQIP tool indicates that most websites were of poor credibility, with minimal information regarding treatment choices and complications. To improve awareness of tonsillitis, there is a need for more informative and patient-centred websites that are compatible with the international quality standard for patient information.


Assuntos
Tonsilectomia , Tonsilite , Adenoidectomia , Criança , Hospitais , Humanos , Internet , Tonsilite/cirurgia
7.
Vestn Otorinolaringol ; 87(3): 72-77, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35818949

RESUMO

At the moment, all over the world there are a large number of various methods of surgical treatment of chronic tonsillitis. In particular: classical tonsillectomy, cryosurgical method for removing the palatine tonsils, shaver tonsillectomy, monopolar and bipolar tonsillectomy, tonsillectomy with an ultrasonic scalpel, bipolar dissection using cutting instruments, laser tonsillectomy, coldablation. This article analyzes the existing methods, describes the fundamental technique for their implementation, as well as their advantages and disadvantages. Given the abundance of various surgical approaches to the treatment of chronic tonsillitis, there is a need for studies aimed at comparative study of their clinical and microbiological efficacy, including the postoperative period.


Assuntos
Tonsilectomia , Tonsilite , Doença Crônica , Humanos , Tonsila Palatina , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos , Tonsilite/diagnóstico , Tonsilite/cirurgia
8.
Artigo em Inglês | MEDLINE | ID: mdl-35886596

RESUMO

BACKGROUND: Vitamin D is essential for many functions of the body. In addition to its primary function of regulating the absorption of calcium in the small intestine, its role in the immune system has recently been studied. The current study aimed to test the impact of vitamin D deficiency on the rate of recurrent acute tonsillitis in children. METHODS: According to Paradise criteria, two hundred forty-two children with recurrent acute tonsillitis were recruited. A group of healthy children (n = 262) was also recruited as controls. Poisson regression was run to predict the number of tonsillitis episodes per year based on vitamin D levels. The mean vitamin D level in the study group was lower than in the control group (p < 0.0001). Poisson regression of the rate of recurrent tonsillitis and vitamin D level (OR = 0.969 (95% CI, 0.962-0.975)) showed that for every single unit increase in vitamin D level, there was a 3.1% decrease in the number of tonsillitis episodes per year (p < 0.0001). CONCLUSIONS: Vitamin D deficiency is associated with higher rates of recurrent acute tonsillitis. Future controlled trials should investigate the role of vitamin D supplementation in reducing the rate of recurrent tonsillitis.


Assuntos
Abscesso Peritonsilar , Transtornos Respiratórios , Tonsilite , Deficiência de Vitamina D , Estudos de Casos e Controles , Criança , Humanos , Jordânia/epidemiologia , Recidiva , Tonsilite/complicações , Tonsilite/epidemiologia , Vitamina D , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia , Vitaminas
9.
Scanning ; 2022: 3149619, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35811760

RESUMO

In order to meet the needs of the analysis and application of regression equation in clinical medicine of tonsil infection, this paper focuses on the semiparametric regression model method, cross-validation method, empirical method, and multiple regression equation analysis of atypical data using regression equation. The general method of analyzing this kind of data is given, and the parameter estimation and hypothesis testing of the model are systematically studied. The experimental results showed that among the 90 paraffin-embedded tissue specimens of chronic tonsillitis and adenoid hypertrophy in this study, 26 out of 49 male children were EBERs positive, accounting for 53.06% of male children (26/49 cases). 28 of the 41 female children were positive, accounting for 68.29 of the female children (28/41 cases). There were 14 cases in infant group, 20 cases in preschool age group, 25 cases in school-age group, and 31 cases in adolescence group; the EBERs-positive rate was 42.86% (6/14 cases) in early childhood and 55.00% in early school-age (11/20 cases), and the EBERs-positive rate was 60.00% in school-age group (15/20 cases) and 70.97% in adolescent group. The results showed that the latent infection rate of adenoid hypertrophy EBV in children with chronic tonsillitis showed no significant difference between genders. It is proved that the regression equation method can meet the needs of clinical analysis and application of tonsil infection.


Assuntos
Tonsila Faríngea , Tonsilite , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hipertrofia , Lactente , Masculino , Tonsila Palatina , Tonsilite/epidemiologia
10.
Sci Rep ; 12(1): 12395, 2022 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-35858968

RESUMO

Fluorescence in situ hybridisation (FISH) is a powerful molecular technique that enables direct visualisation of specific bacterial species. Few studies have established FISH protocols for tonsil tissue in Carnoy's fixative, accordingly limiting its application to investigate the pathogenesis of tonsillar hyperplasia. Tonsil tissue from 24 children undergoing tonsillectomy for either recurrent tonsillitis or sleep-disordered breathing were obtained during a previous study. The specificity of each of the five FISH probes (Fusobacterium spp., Bacteroides spp., Streptococcus spp., Haemophilus influenzae and Pseudomonas spp.) were successfully optimised using pure and mixed bacterial isolates, and in Carnoy's fixed tonsil tissue. Bacteroides spp. were present in 100% of patients with microcolonies. In comparison, the prevalence of Fusobacterium spp. was 93.8%, Streptococcus spp. 85.7%, H. influenzae 82.35% and Pseudomonas spp. 76.5%. Notable differences in the organisation of bacterial taxa within a single microcolony were also observed. This is the first study to establish a robust FISH protocol identifying multiple aerobic and anaerobic bacteria in Carnoy's fixed tonsil tissue. This protocol provides a strong foundation for combining histological and microbiological analyses of Carnoy's fixed tonsil samples. It may also have important implications on the analysis of microorganisms in other human tissues prepared using the same techniques.


Assuntos
Tonsilectomia , Tonsilite , Bactérias/genética , Criança , Fixadores , Haemophilus influenzae , Humanos , Hibridização in Situ Fluorescente , Tonsila Palatina/patologia , Streptococcus , Tonsilite/patologia
11.
Am J Otolaryngol ; 43(5): 103515, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35687938

RESUMO

PURPOSE: The aim of this study was to investigate the correlation between Helicobacter pylori colonization of tonsillar tissue in chronic tonsillitis and in noninfectious hyperplastic tonsils. MATERIALS AND METHODS: All included studies investigated the presence of Helicobacter pylori in tonsillar tissue removed for infectious or noninfectious factors. Included studies must have used an accepted method of testing for Helicobacter pylori. We pooled six eligible studies to perform a traditional meta-analysis. RESULTS: Six studies were included, including 462 patients. Helicobacter pylori does have a significant role in chronic tonsillitis compared with noninfectious indications for tonsillectomy for children population. Detection methods had effects on results. CONCLUSION: The positive rate of Helicobacter pylori in chronic tonsillitis group was significantly higher than that in simple noninfectious group for the pediatric population, but not for adults. We suspected that chronic tonsillitis is likely to be relevant to Helicobacter pylori.


Assuntos
Infecções por Helicobacter , Helicobacter pylori , Tonsilectomia , Tonsilite , Adulto , Criança , Doença Crônica , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Humanos , Tonsila Palatina , Estudos Prospectivos , Tonsilite/complicações , Tonsilite/cirurgia
13.
Eur J Gen Pract ; 28(1): 142-149, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35695024

RESUMO

BACKGROUND: Acute upper respiratory infections are the most common reason for primary physician visits in the community. This study investigated whether the type of antibiotic used to treat streptococcal tonsillitis can reduce the burden by affecting the number of additional visits. OBJECTIVES: To assess the effect of different antibiotic treatments for tonsillitis on the number of additional primary physician visits and the development of infectious or inflammatory sequels. METHODS: This retrospective study included first cases of culture-confirmed streptococcal tonsillitis (n = 242,366, 55.3% females, 57.6% aged 3-15 years) treated in primary clinics throughout Israel between the years 2010 and 2019. Primary outcomes were the number of additional primary physician visits, due to any cause or due to specific upper airway infections. Secondary outcomes were the number of developed complications, such as peritonsillar abscess, post-streptococcal glomerulonephritis, rheumatic fever, post-streptococcal arthritis, chorea and death. RESULTS: Compared to penicillin-V, adjusted incidence rate ratios (IRR) for additional primary physician visits at 30-days were highest for IM benzathine-benzylpenicillin (IRR = 1.46, CI 1.33-1.60, p < .001) and cephalosporin treatment (IRR = 1.27, CI 1.24-1.30, p < .001). Similar results were noted for visits due to specific diagnoses such as recurrent tonsillitis, otitis media and unspecified upper respiratory tract infection. Amoxicillin showed decreased adjusted odds ratio (aOR) of developing complications (aOR = 0.68, CI 0.52-0.89, p < .01 for any complication. aOR = 0.75, CI 0.55-1.02, p = .07 for peritonsillar or retropharyngeal abscess). CONCLUSION: Penicillin-V treatment is associated with fewer additional primary physician visits compared to other antibiotic treatments. Amoxicillin and penicillin-V are associated with fewer complications. These findings are limited by the retrospective nature of the study and lack of adjustment for illness severity. Further prospective studies may be warranted to validate results.


Assuntos
Abscesso Peritonsilar , Faringite , Infecções Respiratórias , Tonsilite , Amoxicilina , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/tratamento farmacológico , Faringite/tratamento farmacológico , Estudos Prospectivos , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Tonsilite/tratamento farmacológico , Resultado do Tratamento
14.
BMC Vet Res ; 18(1): 242, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35751056

RESUMO

BACKGROUND: Canine tonsillectomy is performed due to acute or chronic tonsillitis, neoplasia, trauma or occasionally brachycephalic obstructive airway syndrome. Several tonsillectomy techniques are used but information about surgical complications is scarce. This retrospective study of patient records at the University Animal Hospital aimed to investigate complications related to canine tonsillectomy performed by 20-min clamping combined with monopolar electrosurgery. Inclusion criteria were bilateral tonsillectomy performed with "20-min clamping technique combined with monopolar electrosurgery without suture or ligation". Exclusion criteria were unilateral tonsillectomy, tonsillar neoplasia, additional surgical procedures other than tonsillectomy, cases where sutures were used initially, and cases where unspecified or other methods of tonsillectomy were used. The search of the patient records of the University Animal Hospital included a 10-year period. Complications that required additional anaesthesia were defined as major complications. Minor complications were handled during surgery or after surgery without surgical intervention. RESULTS: Of 39 dogs that fulfilled the inclusion criteria, 11 dogs had complications and out of those 1 dog had two complications. Altogether, of the 12 complications, 2 were classified as major complications and 10 as minor. The most frequent complication was bleeding from the surgical site, in total 11 incidences; 10 dogs had an incidence of bleeding and out of those, 1 dog bled twice, both during and after surgery. Of these 10 dogs that bled, seven incidences of bleeding occurred during surgery and four incidences occurred after surgery. The two dogs with major complications were re-anaesthetized due to bleeding after surgery. No lethal complications occurred and all dogs survived to discharge. CONCLUSIONS: Bleeding during and after surgery was a common complication in dogs after bilateral tonsillectomy using "20-min clamping technique combined with monopolar electrocautery". Revision intervention was often needed, sometimes urgently. Although no comparison was made with another technique, the studied technique should be used with caution.


Assuntos
Doenças do Cão , Tonsilectomia , Tonsilite , Animais , Constrição , Doenças do Cão/cirurgia , Cães , Eletrocirurgia/efeitos adversos , Eletrocirurgia/veterinária , Humanos , Estudos Retrospectivos , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos , Tonsilectomia/veterinária , Tonsilite/cirurgia , Tonsilite/veterinária
15.
Medicine (Baltimore) ; 101(20): e29246, 2022 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-35608426

RESUMO

RATIONALE: Lymphoepithelial cyst of the oral cavity is very rare. Most intraoral lymphoepithelial cysts are observed in the floor of the mouth and very few cases have been reported of its occurrence in the palatine tonsil. PATIENT CONCERNS: A 37-year-old healthy woman with no remarkable medical history visited our department with a complaint of frequent tonsillitis. INTERVENTIONS: On endoscopic examination, yellowish mass was observed in the palatine tonsil and removed via an intraoral approach. The mass was completely removed with the left palatine tonsil. DIAGNOSES OUTCOMES: Histopathological examination and immunohistochemical staining confirmed a Lymphoepithelial cyst. LESSONS: Lymphepithelial cysts of the palatine tonsils are extremely rare and are easily overlooked because there are few reported cases. Therefore, care must be taken when examining the tonsil mass.


Assuntos
Cisto Epidérmico , Doenças da Boca , Tonsilite , Adulto , Cisto Epidérmico/patologia , Feminino , Humanos , Tonsila Palatina/patologia , Tonsila Palatina/cirurgia
16.
Medicina (Kaunas) ; 58(5)2022 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-35630006

RESUMO

Background and Objectives: Tonsillar infections are a common reason to see a physician and lead to a reduction in the patients' health-related quality of life (HRQoL). HRQoL may be an important criterion in decision science and should be taken into account when deciding when to perform tonsillectomy, especially for chronic tonsillitis. The aim of this study was to determine the health utility for different states of tonsillar infections. Materials and Methods: Hospitalized patients with acute tonsillitis or a peritonsillar abscess were asked about their HRQoL with the 15D questionnaire. Patients who had undergone tonsillectomy were reassessed six months postoperatively. Results: In total, 65 patients participated in the study. The health states of acute tonsillitis and peritonsillar abscess had both a utility of 0.72. Six months after tonsillectomy, the mean health utility was 0.95. Conclusions: Our study confirms a substantial reduction in utility due to tonsillar infections. Tonsillectomy significantly improves the utility and therefore HRQoL six months after surgery.


Assuntos
Abscesso Peritonsilar , Tonsilectomia , Tonsilite , Humanos , Abscesso Peritonsilar/cirurgia , Qualidade de Vida , Inquéritos e Questionários , Tonsilite/cirurgia
17.
Int J Pediatr Otorhinolaryngol ; 157: 111128, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35421675

RESUMO

INTRODUCTION: Paediatric tonsillar hyperplasia (TH) is associated with a spectrum of presentations ranging from recurrent tonsillitis (RT) to sleep-disordered breathing (SDB). The underlying pathogenesis of tonsillar hyperplasia remains poorly understood. Previous studies have implicated bacterial microcolonies as targets of host inflammatory cells and as a potential driver of the chronic inflammation seen in TH. The role of atopy in tonsillar hyperplasia is also largely unknown. In this study, we aimed to determine the allergic responses and microbial factors that may influence TH in children. MATERIALS AND METHODS: Paired tonsils and a serum sample were collected from 21 children undergoing tonsillectomy for RT or SDB in the Auckland region. The disposition of immunoglobulin isotypes (IgG, A, M and E) and local inflammatory cells on histological sections of tonsil tissue were determined using immunohistochemistry techniques. Aeroallergen specific IgE (sIgE) and Staphylococcal enterotoxin C specific IgE (SEC-specific IgE) were measured in serum and tonsil tissue using the ImmunoCAP® system. Finally, tonsil bacterial microcolonies were then excised from histological slides using laser microdissection techniques, before undergoing bacterial and fungal amplicon sequencing. RESULTS: There were no significant differences in any of the measured variables between children with RT and SDB symptoms. IgE staining was not associated with increased levels of mast cells, leukocytes or plasma cells. However, sIgE positivity was more frequently found in local tissue than in serum (p = 0.025). A significant association was observed between tissue sIgE levels and tissue SEC-specific IgE levels (r2 = 0.95, p = 0.0001). The most abundant bacterial and fungal genera identified in the microcolonies were Fusobacterium, Sphingomonas, Porphyromonas, Prevotella and Malassezia. DISCUSSION: These results suggest that there is a local IgE response in children with TH. Local IgE production is unrelated to systemic atopy and may play a key role in the pathogenesis of TH. This is the first study to determine the microbial composition of microcolonies in tonsil tissue. These findings enhance current understanding of the microbiology of tonsils in children with TH and have important implications for antibiotic strategies.


Assuntos
Doenças Faríngeas , Síndromes da Apneia do Sono , Tonsilectomia , Tonsilite , Criança , Humanos , Hiperplasia/patologia , Imunoglobulina E , Tonsila Palatina/patologia , Doenças Faríngeas/patologia , Tonsilite/microbiologia
18.
Int J Pediatr Otorhinolaryngol ; 157: 111132, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35427998

RESUMO

OBJECTIVES: It has been suggested that after partial tonsillectomy, referred here as tonsillotomy (TT), the remaining tonsillar tissue might be altered, leading to scarring or chronic tonsillitis. The objectives were to compare the histology of regrown tonsillar tissues with native tonsils and to assess the incidence of reoperations and predictive factors for tonsillar regrowth after TT. METHODS: Tonsillar tissues of 1) children that underwent TT and later requiring resurgery and 2) children operated on for the first time with TT were prospectively analysed. To assess the incidence of resurgery because of tonsillar regrowth and predictive factors for tonsillar regrowth, the data covering TTs and tonsillectomies performed in 2009-2020 were retrospectively retrieved. RESULTS: Altogether 11 children formed the regrowth group, with the control group consisting of 19 children. In the histological analysis of tonsillar tissues, neutrophil infiltration in the epithelium and crypts and severe lymphoplasmacytic infiltration in the epithelium were significantly more frequent in samples of the regrowth group relative to the control group. The number of germinal centres was greater in the regrowth group. In the retrospective analysis of 3141 children, the incidence of resurgery after primary TT was 1.9%. Logistic regression analysis showed that age was the only significant predisposing factor for resurgery. CONCLUSION: Inflammatory cells were present more often in regrown tonsillar tissues but there was no evidence of severe chronic inflammation or scarring in the regrown tonsils. The risk of resurgery after TT was low. Young age predisposed to tonsillar regrowth, no other risk factors were found.


Assuntos
Tonsilectomia , Tonsilite , Criança , Cicatriz/cirurgia , Humanos , Tonsila Palatina/patologia , Estudos Retrospectivos , Fatores de Risco , Tonsilectomia/efeitos adversos , Tonsilite/patologia
20.
BMJ Open ; 12(4): e056551, 2022 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-35477880

RESUMO

OBJECTIVES: To compare the application of indications, demographics, surgical and haemostatic techniques in tonsil surgery in three countries. DESIGN: Non-randomised, prospective, observational cohort. SETTING: All patients registered in the National Tonsil Surgery Quality Registers in Sweden, Norway and West Jutland, Denmark. PARTICIPANTS: Data were retrieved from 2017 to 2019; registered surgeries: Sweden: 20 833; Norway: 10 294 and West Jutland, Denmark: 505. RESULTS: Tonsil surgery for obstruction was twice as common in Sweden (62.2%) compared with Norway (31%) and Denmark (27.7%). Recurrent tonsillitis was registered twice as frequently in Norway (35.7%) and Denmark (39%) compared with Sweden (16.7%). Chronic tonsillitis was registered more frequently in Norway (29.8%) than in Sweden (13.8%) and Denmark (12.7%). Day surgery (>76%) was comparable. The higher frequency of obstruction in Sweden affected age and gender distributions: Sweden (7 years, 50.4% boys), Norway (17 y, 42.1%) and Denmark (19 y, 38.4%). For obstructive disorders, tonsillotomy with adenoidectomy was used in a majority of Swedish children (72%), whereas tonsillectomy with or without adenoidectomy dominated in Norway (53.5%) and Denmark (57.9%). Cold steel was the technique of choice for tonsillectomy in all three countries. For tonsillotomy, hot dissection techniques dominated in all countries. Disparities were observed with regard to haemostatic techniques. Bipolar diathermy was commonly used in all countries. Monopolar diathermy was practically only used in Sweden. Infiltration with epinephrine in the tonsillar bed was registered in Sweden and Norway but not at all in Denmark. Combined cold surgical and cold haemostatic techniques were more commonly used in Sweden (22.7%) than in Norway (10.4%) and Denmark (6.2%). CONCLUSIONS: This study demonstrates disparities among the Nordic countries in tonsil surgery in terms of indications plus surgical and haemostatic techniques. Increased coverage and further monitoring of outcomes is needed to identify best practices and ideal guidelines for improved care.


Assuntos
Tonsila Palatina , Tonsilite , Criança , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Noruega/epidemiologia , Tonsila Palatina/cirurgia , Estudos Prospectivos , Sistema de Registros , Suécia/epidemiologia , Tonsilite/epidemiologia , Tonsilite/cirurgia
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